AB0265 SLEEP QUALITY IN PATIENTS WITH RHEUMATOID ARTHRITIS: A SINGLE CENTER EXPERIENCE FROM JODHPUR, INDIA
Authors: N. K, A. Kumar P H, R. Sivaprasad, S. Nandagopal, A. Garg, M. K. Garg, M. Gopalakrishnan
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Sleep disorders are prevalent in rheumatoid arthritis (RA). Sleep is closely related to disease activity, depression, stress, fatigue and pain [1]. Community prevalence of sleep disorders in India varies from 6.2% to 36.3% [2,3]. Studies assessing sleep quality in the Indian population with RA are limited. <h3>Objectives</h3> To assess the prevalence of impaired sleep quality using Pittsburgh Sleep Quality Index (PSQI) and determine factors predicting impaired sleep quality in patients with RA. <h3>Methods</h3> A cross-sectional study was conducted in patients with RA presenting to our rheumatology clinic after informed consent and Ethics Committee approval from January 2021. Sleep quality was assessed by PSQI, depression by Patient Health Questionnaire (PHQ-9) and Quality of life by Indian Health Assessment Questionnaire (IHAQ). Disease activity was assessed using Disease Activity Index (DAS28 CRP) and Clinical Disease Activity Index (CDAI). Serum samples for interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α) were collected and stored at -80<sup>0</sup> C. Relationship of fatigue was examined with age, serum TNF-α, IL-1, IL-6, CDAI, DAS28 CRP and patient global assessment (PtGA) using Spearman correlation coefficient. Linear regression analysis was performed to determine the predictors of impaired sleep quality in patients with RA. <h3>Results</h3> One hundred and fifty-four patients were enrolled, 133 were females (86.3%). Median pain VAS score was 6[2]. Mean DAS was 4.35 ± 1.31, mean CDAI: 19.75 ± 7.91 and median IHAQ was 9.5[8]. The prevalence of depression (PHQ-9 &gt;10) was 5.8% (n = 9) with a median PHQ-9 of 2[3]. One patient was on tofacitinib, 20 were on methotrexate monotherapy and others were on combination of conventional DMARDs. The prevalence of impaired sleep (PSQI &gt;5) was 8.4% (n = 13) with a median PSQI of 2[2]. PSQI had significant correlation with PHQ-9 (r = 0.471, p&lt;0.0001), IHAQ (r = 0.288, p&lt;0.0001), DAS28 (r = 0.197, p = 0.015) and CDAI (r = 0.235 p = 0.003). Age, pain VAS, serum TNF-α, IL-1 and IL-6 had no correlation with PSQI. Among individual components of DAS, PtGA (r = 0.296 p &lt;0.0001) alone correlated with PSQI. PHQ-9, IHAQ and PtGA were significant predictors of impaired sleep quality (Table 1). <h3>Conclusion</h3> Compared to other studies within India, our patients had very low prevalence of impaired sleep quality. Sleep quality significantly influences disease activity likely by affecting PtGA. Risk factors for poor sleep quality are presence of depression, poor quality of life and patient global assessment of disease activity. Hence a holistic management of RA must involve addressing these risk factors. <h3>References</h3> [1] McBeth J, Dixon WG, Moore SM, Hellman B, James B, Kyle SD, et al. Sleep Disturbance and Quality of Life in Rheumatoid Arthritis: Prospective mHealth Study. J Med Internet Res. 2022 Apr 22;24(4):e32825. [2] Ramaswamy G, Premarajan KC, Kar SS, Narayan SK, Thekkur P. Prevalence and determinants of sleep disorders in a community in rural southern India. Natl Med J India. 2020 May 1;33:132. [3] Panda S, Taly AB, Sinha S, Gururaj G, Girish N, Nagaraja D. Sleep-related disorders among a healthy population in South India. Neurol India. 2012 Jan 1;60(1):68. <h3>Acknowledgements</h3> None. <h3>Disclosure of Interests</h3> None Declared.